Healthcare Provider Details

I. General information

NPI: 1295657419
Provider Name (Legal Business Name): JACQUELINE GREGORY PYCHIATRIC NURSE PRACTITIONER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 NACHES WENAS RD LOT 156
SELAH WA
98942-1448
US

IV. Provider business mailing address

1769 NACHES WENAS RD LOT 156
SELAH WA
98942-1448
US

V. Phone/Fax

Practice location:
  • Phone: 509-854-8722
  • Fax: 307-202-4873
Mailing address:
  • Phone: 509-854-8722
  • Fax: 307-202-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUELINE GREGORY
Title or Position: OWNER
Credential: PHD, FNP-C PMHNP-BC
Phone: 509-854-8722